Posterior Urethral Valve (PUV) is a serious congenital condition seen exclusively in male infants. In this disorder, an abnormal membranous fold develops in the posterior urethra — the tube responsible for draining urine from the bladder. This membrane partially or completely obstructs urine flow, preventing the bladder from emptying effectively.
The obstruction creates increased pressure within the urinary tract, leading to dilation of the ureters and kidneys (hydroureteronephrosis). If left untreated, this progressive back pressure can result in irreversible kidney damage and, in severe cases, end-stage renal failure. The estimated incidence of PUV is approximately 1 in 800 male newborns.
Early Signs and Symptoms:
PUV may be suspected during routine antenatal ultrasound. Typical prenatal findings include:
Bilateral dilated kidneys and ureters
Distended, thick-walled urinary bladder
After birth, affected infants or children may present with:
Weak or poor urinary stream
Straining during urination
Recurrent urinary tract infections (UTIs)
Failure to thrive in severe cases
Early detection is crucial to minimize long-term renal complications.
Diagnostic Evaluation:
If clinical findings and ultrasound suggest PUV, the definitive diagnostic test is a Voiding Cystourethrogram (VCUG). During this specialized imaging procedure, the bladder is filled with contrast dye and X-ray fluoroscopy is used to visualize the urethra during urination. VCUG confirms the presence and severity of the obstructing valves.
Additional investigations may include blood tests to assess kidney function and monitoring for electrolyte imbalance.
Goals of Treatment:
The primary objectives in managing PUV are:
Relieving urethral obstruction
Preserving kidney function
Preventing recurrent urinary infections
Optimizing bladder function
Timely intervention significantly improves long-term outcomes.
Endoscopic Valve Ablation:
The standard treatment for PUV is endoscopic valve ablation. This minimally invasive procedure is performed using a cystoscope — a thin instrument inserted through the urethra into the bladder. Under direct visualization, the obstructing valves are carefully incised to restore normal urine flow.
This technique can be safely performed even in newborns. Early relief of obstruction reduces back pressure on the kidneys and helps prevent further damage.
Temporary Urinary Diversion:
In certain severe or unstable cases, immediate valve ablation may not be feasible. Temporary urinary diversion procedures such as vesicostomy or ureterostomy may be required. In these procedures, a controlled opening is created in the bladder or ureter to allow urine drainage externally, reducing pressure on the kidneys until definitive treatment can be completed.
Long-Term Follow-Up and Care:
PUV is not merely a surgical condition; it requires ongoing multidisciplinary follow-up. Even after successful valve ablation, children may develop bladder dysfunction or varying degrees of kidney impairment.
Long-term care includes:
Regular ultrasound to monitor kidney size and swelling
Periodic urine tests to detect infections
Kidney function tests
Monitoring growth and development
Consultation with a pediatric nephrologis
Early and structured follow-up improves bladder dynamics and protects renal health over time.
Expert Pediatric Surgical Care
For families seeking Posterior Urethral Valve Treatment in Delhi, specialized pediatric urological expertise is essential. Dr. Prashant Jain is widely regarded as the Best Pediatric Surgeon in Delhi, with extensive experience in managing complex congenital urological conditions, including PUV. His approach emphasizes early diagnosis, minimally invasive intervention, and comprehensive long-term monitoring to safeguard kidney function and ensure healthy growth.
With timely surgical correction and coordinated follow-up, children diagnosed with posterior urethral valve can achieve significantly improved outcomes and quality of life.
#Posterior Urethral Valve Treatment In Delhi #Hypospadias Surgery In Delhi
